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PubMed1998

The furosemide test and vestibular status in Meniere's disease.

A total of 62 ears of patients with typical Meniere's disease was examined by the furosemide test to detect endolymphatic hydrops. In 95% of the normal control group, the per cent change in the maximum velocity of the slow phase of caloric nystagmus (MVS) after injection of furosemide was under 10%. Therefore, a positive furosemide test was defined as a change in MVS of more than 10%. Thirty-five (56%) of the 62 ears with typical Meniere's disease showed a positive furosemide test. When the affected ears were divided into two groups according to vestibular symptoms, only 11 (38%) of 29 inactive ears were positive while 24 (73%) of 33 active ears were positive. There was a significant difference in the positive rate of the furosemide test between the ears with clinically inactive and active vestibular disease. The per cent canal paresis (CP%) was determined to assess canal excitability and a CP%> 25% was defined as canal paresis. There was no significant difference in the furosemide test positive rate between ears with canal paresis and ears with a normal CP%, although the former tended to show a greater MVS change. The response to the furosemide test showed no relationship to the results of pure tone audiometry. In conclusion, the furosemide test appears to indicate the vestibular status in various stages of Meniere's disease.

Ear Canal↗
PubMed2000

Intractable benign paroxysmal positional vertigo in patients with Meniere's disease.

OBJECTIVE: To provide a detailed description of the coexistence of benign paroxysmal positional vertigo (BPPV) and Meniere's disease in individuals and to offer a possible mechanism that explains the findings in these patients. STUDY DESIGN: Retrospective. METHODS: Chart review. RESULTS: Of 162 patients diagnosed with Meniere's disease between January 1998 and January 1999, 9 were found to have both "definite" Meniere's disease and "certain" BPPV. Meniere's symptoms preceded the onset of BPPV in all of our patients. Seven of the 9 patients were female. Except for one patient who experienced BPPV bilaterally, BPPV was limited to the same ear as the Meniere's disease. All patients presented with intractable BPPV that did not respond completely to otolith repositioning procedures. A detailed description of five patients is presented. CONCLUSION: Our data, in conjunction with that of others, suggest that Meniere's disease may predispose patients to intractable BPPV. Hydropically induced damage to the maculae of the utricle and saccule or partial obstruction of the membranous labyrinth may be possible mechanisms that explain the coexistence of Meniere's disease and BPPV.

Acoustic Maculae↗
PubMed1994

Dizziness in aging: a retrospective study of 1194 cases.

In the Royal Victoria Hospital dizziness clinic, 1194 of 9767 (12.22%) patients were 70 years of age or older on the day of the first visit. There were 750 women and 444 men, with no difference in age distribution (p > 0.9). In 367 (27.04%) cases (percentages given as "cases" refer to the number of diagnoses [N = 1357], not the number of patients [N = 1194]), the symptoms were nonspecific, and the diagnosis was uncertain. In 530 (39.13%) patients, paroxysmal positional vertigo was either confirmed or strongly suspected. In the 241 of 254 (94.88%) confirmed cases, the observed paroxysmal nystagmus was compatible with excitation of the posterior semicircular canal. In 119 (8.77%) patients, the dizziness could not be attributed to neurologic or vestibular disease. Meniere's disease, vestibular neuronitis, vascular episodes, and tumors were next in prevalence. The following conclusions were reached: (1) although no difference was found in age distribution between women and men, dizziness was more prevalent among women, which may be because of the higher survival rate of women; (2) the prevalence of paroxysmal positional vertigo was high, with apparent involvement of the posterior semicircular canal in most cases (it is strongly suspected that paroxysmal positional vertigo is frequently misdiagnosed as vascular disease in advanced age); and (3) multisensory deficits, drugs, or systemic diseases, common in the elderly, may cause dizziness. Syndromes affecting the vestibular function, however, may be more prevalent in advanced age than is generally estimated.

Aged↗
PubMed1983

Surgical management of vestibular Meniere's disease with endolymphatic mastoid shunt.

The early stages of Meniere's disease may consist only of vestibular symptoms. These patients with vertigo alone may be incapacitated by this condition. A great many of these patients are unresponsive to medical therapy and tend to progress to cochleovestibular disease. Early surgery on such individuals may decrease vertigo and give the added benefit of preserving hearing. This paper reports the results of endolymphatic mastoid shunts performed on 24 patients with normal hearing who had medically uncontrolled vestibular Meniere's disease. The patients underwent surgery between 1978 and 1981, and each has been followed for at least 1 year. Vertigo was decreased or abolished in 21 of 24 patients (87%). Hearing remained unchanged in 19 of the 24 patients (79%) and was mildly impaired postoperatively in 4(16.7%). Only 1 patient had moderate postoperative hearing loss. Of the 5 patients with reduced hearing, 4 had improvement of vertigo. There were no cases of surgically-induced deafness.

Adult↗
PubMed2003

Serum antidiuretic hormone levels in patients with unilateral Meniere's disease.

OBJECTIVES/HYPOTHESIS: Prior studies have indicated a possible role of antidiuretic hormone (ADH) in the pathogenesis of Meniere's disease. Animal studies have shown presence of ADH receptors in the inner ear, and chronic vasopressin administration has been shown to induce endolymphatic hydrops. Furthermore, elevation of serum ADH levels in human has been noted in patients with Meniere's disease. The goal of the study report was to analyze ADH levels in a series of patients with definite unilateral Meniere's disease to further investigate this relationship. STUDY DESIGN: Retrospective analysis METHODS: Antidiuretic hormone levels were obtained from 26 consecutive patients with a diagnosis of definite Meniere's disease as defined by the 1995 guidelines from the Committee of Hearing and Equilibrium (American Academy of Otolaryngology-Head and Neck Surgery). The ADH levels were drawn for each patient within one week of an acute episode of vertigo. These values were compared to ADH levels from 31 healthy volunteers. Statistical analysis was performed using a two-tailed t test. RESULTS: Mean ADH level for patients with Meniere's disease was 4.07 pg/mL (SD = 2.82 pg/mL) and for the control group, 3.37 pg/mL (SD = 1.48 pg/mL). The difference in ADH levels was not statistically significant (P >.05). CONCLUSIONS: Although previous reports have demonstrated a possible role of ADH in the pathogenesis of Meniere's disease, the study did not show a statistically significant elevation of ADH levels in patients with unilateral Meniere's disease. Before excluding an ADH-inner ear pathogenic relationship, ADH levels in patients with bilateral Meniere's disease should be investigated.

Adult↗
PubMed2003

[Immuno-pathogenesis in Meniere's disease].

Since the report of Duke in which an allergic etiology was considered to be the cause of Meniere's disease, the hypothesis that a certain type of Meniere's disease is generated through immuno-pathological mechanisms has been advocated for 70 years. During this period, another entity of immune-mediated inner ear disorders, i. e., autoimmune inner ear disease was introduced. Fundamental immunological phenomena of the inner ear have been rapidly elucidated since 1980. The endolymphatic sac is the only site which contains immuno-competent cells within the inner ear. The inner ear is capable of mounting active immune responses when appropriately stimulated and the endolymphatic sac plays an integral function for inner ear immune response. Actually, many reports have been published that link immunity and Meniere's disease with a variety of proposed immune-related etiologies from autoimmunity to non-autoimmunity. It is suggested that immune injury to the endolymphatic sac plays an important role in the pathogenesis of Meniere's disease. These functional and morphological circumstances strongly suggest that an immunological etiology of Meniere's disease is not theoretically unfounded.

Autoimmune Diseases↗
PubMed2005

Trends in the diagnosis and the management of Meniere's disease: results of a survey.

OBJECTIVE: To determine the practices of the American Neurotology Society (ANS) membership in the evaluation and treatment of the Meniere's patient. STUDY DESIGN: Prospective. INTERVENTION: Questionnaire. MAIN OUTCOME MEASURE: Respondents' response to questions pertaining to the diagnostic and therapeutic practices in the management of Meniere's disease. RESULTS: Three hundred members of ANS were mailed a 15-item questionnaire. Two hundred three responded, for a 67.7% response rate. For the diagnosis of Meniere's disease, 1 in 3 practitioners relied solely on history, physical exam, and audiometry, whereas 2 in 3 relied in part on adjunctive tests, such as electrocochleography (ECOG) and electronystagmography (ENG). Two in 3 practitioners pursued retrocochlear studies on initial evaluation, with the overwhelming majority using MRI. In treating Meniere's disease, conservative medical management was preferred. For medically recalcitrant Meniere's disease, endolymphatic sac surgery (ESS) was the most commonly employed initial intervention (50%), followed by transtympanic gentamicin (38%). Currently, <10% routinely recommend the Meniett device. Eighty-three percent include ESS as a therapeutic option for medically recalcitrant Meniere's disease. The vast majority continue to perform surgical labyrinthectomies and vestibular nerve sections for Meniere's disease. CONCLUSIONS: Meniere's disease continues to pose a difficult diagnostic and therapeutic problem, resulting in heterogeneous approaches to both evaluation and treatment. Despite the 1995 American Academy of Otolaryngology guidelines in the diagnosis of Meniere's disease, most clinicians rely in part on ENG or ECOG in diagnosing Meniere's disease. Furthermore, despite the passing of 20 years since the publications claiming a purely placebo effect, ESS is the most commonly employed initial surgical treatment for Meniere's disease.

Audiometry, Evoked Response↗
PubMed1997

The treatment of hearing loss in Meniere's disease.

A review of the recent literature concerning hearing loss and Meniere's disease is presented. A compilation of the change in hearing resulting from endolymphatic sac surgery, vestibular nerve section, and intratympanic gentamicin injection and a summary of the results of pharmacologic interventions is tabulated for 1986 to 1996. Although vertigo control is variable with the above treatment strategies, hearing loss does not appear altered by any of them when compared with the natural history of hearing loss associated with Meniere's disease. Further investigation is necessary to understand the underlying cause of hearing loss in Meniere's disease and to eventually control its progression.

Adolescent↗
PubMed2001

Microdose gentamicin administration via the round window microcatheter: results in patients with Meniere's disease.

Transtympanic gentamicin is becoming increasingly popular in the treatment of Meniere's disease. In this report we examine our experience with the use of microdose gentamicin via the Round Window Microcatheter for the treatment of Meniere's disease. Thirty-six patients were treated with gentamicin administration via the Round Window Microcatheter between July 1997 and August 2000. The patients all underwent 10 days of continuous treatment with a total dose of 2.4-3.75 mg of gentamicin (10 mg/ml). All patients had extensive pre-, intra-, and post-therapy auditory and vestibular testing. In this group, vertigo was eliminated in 89% of the patients, and tinnitus and pressure were significantly reduced in over 60% of the patients. Only one patient suffered a significant hearing loss and, most importantly, in all but one patient vestibular function was improved or normalized after treatment. Round Window Microcatheter-administered microdose gentamicin is an exciting new treatment for Meniere's disease. Preliminary results indicate that vertigo can be controlled without a significant reduction in cochlear or vestibular function in most patients. These results suggest that this therapy may be acting at a non-hair cell site. Our results are compared to the published literature examining transtympanic injection. In addition, the underlying science supporting this type of treatment is examined.

Adult↗
PubMed2001

Effects of exposing the opened endolymphatic sac to large doses of steroids to treat intractable Meniere's disease.

To enhance the effect of treatment for intractable Meniere's disease, we exposed the opened endolymphatic sac to high concentrations of steroids. This technique--endolymphatic sac drainage and steroid instillation surgery--involves the application of a mass of prednisolone followed by absorbable gelatin sponges soaked in a high concentration of dexamethasone into a sac lumen opened and expanded with a bundle of absorbable gelatin film. These sponges are also placed around the sac and coated with biochemical adhesive so that the medicine is slowly delivered into the sac over a prolonged period of time by means of a natural sustained-release vehicle. The short-term results (6 to 14 months) in 12 patients with Meniere's disease, including those in stage IV, treated by the above techniques showed that definitive spells were completely controlled in all cases. Hearing was improved, and annoyance due to tinnitus was decreased in all cases except one.

Adult↗
PubMed2005

The role of vestibular rehabilitation in the treatment of Meniere's disease.

OBJECTIVE: To study the role of vestibular rehabilitation is treating patients with Meniere's disease. METHODS: We examined all Meniere's patients presenting to our tertiary care specialized vestibular clinic during a 1-year period. All patients underwent a standardized history and physical examination, a complete auditory-vestibular test battery, and a set of physical therapy tools to measure balance function. RESULTS: A subset of patients suffered from disequilibrium or unsteadiness between attacks. Once the acute fluctuating symptoms of Meniere's were controlled in this group of individuals, all of them underwent vestibular physical therapy and demonstrated significant improvement in balance function on both objective and self-report tests. CONCLUSIONS: Due to the fluctuating nature of the disorder, vestibular physical therapy has had a limited role in the treatment of Meniere's disease. In general, rehabilitation has been used only as a postoperative treatment for the acute vertigo seen after vestibular neurectomy or labyrinthectomy. This is the first report advocating the role of vestibular physical therapy in a group of patients receiving medical therapy of intraear medicines (other that gentamicin).

Adult↗
PubMed2000

External aperture of the vestibular aqueduct in Meniere's disease.

OBJECTIVE: To study the relationship of the length of the external aperture of the vestibular aqueduct and the ratio of the summating potential and action potential (SP:AP) in patients with Meniere's disease. STUDY DESIGN: Retrospective case study. SETTING: Neurotology referral center. PATIENTS: Fifty-four patients with Meniere's disease and nine control subjects without Meniere's disease. INTERVENTION: The external aperture of the vestibular aqueduct was measured from a three-dimensional surface reconstruction computed tomography scan. Transtympanic electrocochleography was performed on patients with Meniere's disease. MAIN OUTCOME MEASURE: The length of the external aperture of the vestibular aqueduct in the Meniere's disease ears was related to the SP:AP ratio in the Meniere's disease ears and compared with controls. RESULTS: The average length of the external aperture was 3.79 +/- 2.92 mm in Meniere's disease ears and 5.35 +/- 1.73 mm in the control ears (p < 0.05). An enlarged SP:AP ratio was found in 95% of ears in the group with nonvisible external apertures of the vestibular aqueduct, 91% of ears in the <5 mm group, 58% of ears in the 5-7 mm group, and 29% of ears in the >7 mm group (chi-square = 24.814; p = 0.000). CONCLUSIONS: The length of the external aperture of the vestibular aqueduct in patients with Meniere's disease is significantly shorter than in those without Meniere's disease. Endolymphatic hydrops, evidenced by an enlarged SP:AP ratio, was related to the length of the external aperture of the vestibular aqueduct. The shorter the external aperture, the more often the SP:AP ratio was enlarged. A short or nonvisible external aperture of the vestibular aqueduct is a predisposing factor to the development of Meniere's disease.

Audiometry, Evoked Response↗
PubMed2006

Meniere's disease: prevalence of contralateral ear involvement.

OBJECTIVE: Determine the prevalence and time interval for conversion from unilateral to bilateral involvement in Meniere's disease and cochlear hydrops. STUDY DESIGN AND SETTING: Retrospective chart review in a tertiary otologic referral center. PATIENTS: 232 patients diagnosed with Meniere's Disease (n=186) or cochlear hydrops (n=46) between 1959 and 2001, who visited the clinic over a five-year period between 1997-2001 and have at least 2 audiograms more than 12 months apart. MAIN OUTCOME MEASURES: Prevalence of cochlear hydrops relative to Meniere's Disease, rate of progression from unilateral to bilateral involvement; interval between unilateral onset of symptoms and bilateral involvement; and rate of progression from cochlear hydrops to Meniere's disease. RESULTS: Initial diagnosis was Meniere's disease in 71% and cochlear hydrops in 29% of all 950 hydropic patients presenting between 1997 and 2001. In the study sample, Meniere's disease was bilateral at presentation in 11%; an additional 12% (14% of unilaterals) became bilateral during the follow-up period. At presentation, 6.5% of cochlear hydrops patients were bilateral, with another 26% becoming bilateral. Conversion from cochlear hydrops to Meniere's disease occurred in 33% and some of these are included among the bilateral. The average time interval for conversion from unilateral to bilateral Meniere's was 7.6 years (SD=7.0 years). CONCLUSION: Most otologists are aware of the potential for contralateral ear involvement and conversion from cochlear hydrops to Meniere's disease after diagnosis. These changes are significant, require long-term follow-up for detection, and may necessitate further treatment. Patients should be counseled regarding this potential when interventions are considered, especially with respect to ablative treatments.

Adult↗
PubMed1981

Temporal bone characteristics in Meniere's disease.

The petrous portion of the temporal bone in patients with Meniere's disease differs from that of healthy individuals mainly in its lack of periaqueductal pneumatization and its consequently short and narrow vestibular aqueduct. Diminished pneumatization may have an impact upon the tomographic reproducibility of the aqueduct. A total lack of periaqueductal pneumatization is prevalent in long-standing Meniere's disease. Tomography may serve as a tool by providing a basis for the choice of surgical procedure. Roentgenologic and histologic studies have indicated that the pars rugosa of the endolymphatic sac in normals mainly is housed inside the distal part of the vestibular aqueduct. In patients with Meniere's disease, the sac might be located outside the aqueduct and therefore deprived of the functions of the loose and highly vascular tissue normally surrounding it within the aqueduct. This might influence the total vascular supply of the sac, thereby interfering with its resorptive and immunodefensive functions.

Endolymphatic Sac↗